Case Report
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World J Gastroenterol. Jan 14, 2014; 20(2): 593-597
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.593
An extremely rare case of pancreatic metastasis of esophageal squamous cell carcinoma
Hiroshi Okamoto, Yasuyuki Hara, Masahiro Chin, Motohisa Hagiwara, Yuji Onodera, Shinichiro Horii, Yasuhiro Shirahata, Takashi Kamei, Eiji Hashizume, Noriaki Ohuchi
Hiroshi Okamoto, Yasuyuki Hara, Masahiro Chin, Motohisa Hagiwara, Yuji Onodera, Shinichiro Horii, Yasuhiro Shirahata, Eiji Hashizume, Department of Surgery, Nihonkai General Hospital, Sakata 998-8501, Japan
Hiroshi Okamoto, Yasuyuki Hara, Motohisa Hagiwara, Takashi Kamei, Noriaki Ohuchi, Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai 980-8574, Japan
Author contributions: Okamoto H is the main author of this article; Hara Y, Chin M, Hagiwara M, Onodera Y, Horii S and Hashizume E were attending doctors and performed clinical treatment including surgical operation; Shirahata Y, Kamei T and Ohuchi N reviewed the manuscript; all authors have read and approved the final manuscript.
Correspondence to: Hiroshi Okamoto, MD, PhD, Department of Surgery, Nihonkai General Hospital, 30 Akiho-machi, Sakata 998-8501, Japan. hi-ok-0531@med.tohoku.ac.jp
Telephone: +81-234-262001 Fax: +81-234-265114
Received: September 12, 2013
Revised: October 30, 2013
Accepted: October 30, 2013
Published online: January 14, 2014
Processing time: 128 Days and 19.1 Hours
Abstract

We report a rare case of a 68-year-old male with metachronous pancreatic metastasis that was resected 2 years after salvage esophagectomy for local recurrence of esophageal squamous cell carcinoma (ESCC). Two years and 8 mo ago, he had undergone definitive chemoradiotherapy for the lower thoracic ESCC and achieved a complete response. Chemoradiotherapy used the protocol of the Japan Clinical Oncology Group trial 9906. Approximately 8 mo later, he developed a local recurrence of the ESCC and underwent thoracoscopic salvage esophagectomy followed by reconstruction with a conduit colon graft via a subcutaneous route. Recently, a tumor of the pancreatic body was found on routine follow-up computed tomography (CT). The tumor diameter was 15 mm on CT, and the maximum standardized uptake value of the lesion was 5.49 at 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography, strongly suggesting pancreatic cancer. In addition, all tumor markers were within the reference intervals. Therefore, distal pancreatectomy was performed with the resultant histological diagnosis being confirmed as pancreatic metastasis of the ESCC. He was treated with adjuvant chemotherapy, and there has been no evidence of recurrence 9 mo after the surgery. Resection of pancreatic metastasis offers a good prognosis and should be considered for solitary ESCC metastasis.

Keywords: Metachronous pancreatic metastasis; Esophagus; Squamous cell carcinoma; Pancreatectomy; Salvage esophagectomy; Definitive chemoradiotherapy

Core tip: This report a 68-year-old male presenting with a pancreatic tumor following esophageal squamous cell carcinoma (ESCC) treated with curative chemoradiotherapy and thoracoscopic salvage esophagectomy approximately 2 years previously. He was treated with distal pancreatectomy and histologically diagnosed as a rare case of metachronous pancreatic metastasis of ESCC. Resection of pancreatic metastasis offers a good prognosis and should be considered for solitary ESCC metastasis. Both this case and a review of the relevant literature support this view.